EHA mpox guidelines case definition.pptx

EHA mpox

1. Monkeypox جدري القرده Prepared by : Dr Muhammad tolba Epidemiologist Ipc practitioner ادرا ة مكافحة العدوي والشئون الوقائية هيئة الرعاية الصحية Contents:- What is monkeypox ? The Causative Agent and Natural Host The incubation period Modes of Transmission Signs and Symptoms Epidemiology Diagnosis Differential diagnosis Pre & Post exposure prophylaxis Preventive measures

2. What is monkeypox? It is a viral infection Human monkeypox is a zoonosis Mpox is an illness caused by the monkeypox virus which can spread mainly through close contact, and through the environment to people via contaminated things and surfaces, from infected animals to people who have contact with them. new preferred term “mpox” as a synonym for monkeypox Also termed “MPXV infection”

3. The Causative Agent and Natural Host Monkeypox virus is an enveloped double-stranded DNA virus that belongs to the Orthopoxvirus genus of the Poxviridae family , the same family of the virus that causes smallpox (eradicated in 1980). While mpox is not related to chickenpox, which is caused by the varicella virus, it is not an orthopoxvirus . Currently, two phylogenetically distinct clades have been identified : Clade I (formerly known as Central African (Congo Basin)) Clade II (formerly known as West African clade). Additionally, the Clade II consists of two subclades. In 2022-2023 a global outbreak of mopx mainly caused by clade IIb . Mpox can infect various animal species, but the natural host is unknown . This includes rope squirrels, tree squirrels, Gambian pouched rats, sooty mangabey , and other species.

4. The incubation period Usually from 6 to 13 days but can range from 5 to 21 days .

5. Modes of Transmission Transmission of the Monkeypox virus occurs when a person comes into contact with the virus through an infected human, contaminated materials, or infected animal . Human-to-human transmission mainly through direct physical contact with a person having mpox symptoms or indirect contact with contaminated surfaces or personal belongings. Direct contact face-to-face (talking or breathing) skin-to-skin (touching or vaginal/anal sex) mouth-to-mouth (kissing) mouth-to-skin contact (oral sex or kissing the skin)

6. Modes of Transmission during or after birth through skin-to-skin contact. respiratory droplets or short-range aerosols from prolonged close contact. Trans placental in infected pregnant women to their fetus . Indirect contact Through percutaneous injury has also been documented in health workers during specimen collection as well as in the community setting in particular tattoo parlors . contact with contaminated surfaces or personal belongings .

7. Modes of Transmission Animal to human transmission occurs from infected animals such as “cats , dogs, hamsters, gerbils” to humans from bites or scratches, or during activities such as hunting, skinning, trapping, cooking, playing with carcasses, or eating animals N B. The extent of viral circulation in animal populations is not entirely known and further studies are underway . In 2022-2023 a global outbreak of mopx, most cases have been transmitted through close, intimate contact with symptomatic people, primarily during sexual contact.

8. Portal of Entry:- The virus enters the body through:- broken skin, mucosal surfaces (e g oral, pharyngeal, ocular, genital, anorectal), or via the respiratory tract . People with multiple sexual partners are at higher risk

9. Epidemiology Mpox is a viral illness first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys in a research facility, so the name "Monkeypox" comes from this event. In 1970, the first human case of mpox was recorded in the Democratic Republic of the Congo (DRC ). It has become endemic in parts of Central and West Africa and is most concentrated in the Democratic Republic of the Congo.

10. Epidemiology In 2003, the first mpox outbreak outside Africa was in the United States of America, with over 70 cases, and was linked to contact with infected pet prairie dogs . mpox has also been reported in travelers from Nigeria to Israel and the United Kingdom in sporadic cases between 2018 and 2022 . On 14 May 2022, a cluster of mpox cases was reported in the United Kingdom, and these cases have no history of travel or travel related case . Since the UK's reporting of cases, several other countries have reported cases of mpox around the world, mainly in Europe and North America . All infections characterized so far among the recent clusters have been due to the West African clade. This is the first time that chains of transmission are reported outside Africa without known epidemiological links to West or Central Africa. On 23 July 2022, the Director General of the World Health Organization (WHO) declared this multi-country outbreak of mpox a Public Health Emergency of International Concern (PHEIC).

11. Epidemiology This multi-country outbreak of mpox which affected 111 countries, resulted in more than 87,000 cases and 140 deaths , according to the World Health Organization (WHO). On May 2023, there has been a significant decline in cases over the last three months compared to the previous three months, with almost 90% fewer cases reported. As a result, the committee recommended to the Director-General of WHO that the outbreak of mpox disease no longer constitutes a health emergency of international concern (PHEIC). On May 11, 2023, the Director-General of WHO accepted this recommendation and declared that mpox no longer constituted a public health emergency of international concern . 14 August 2024 , WHO Director-General declares mpox outbreak a public health emergency of international concern

12. Current situation:-

13. Signs and Symptoms After the incubation period, the illness typically lasts for 2−4 weeks of infection, and it can be divided into two periods: The invasion period • Usually lasts between 0-5 days. • Characterized by fever, intense headache, lymphadenopathy , back pain, myalgia, and intense asthenia (lack of energy). • However, prodromal symptoms can be absent or follow rash onset. • Lymphadenopathy is a distinctive feature of mpox compared to other diseases that may initially appear similar ( chickenpox, measles, smallpox).

14. Signs and Symptoms The skin eruption period Usually begins within 1-3 days of the appearance of fever. Pattern: scattered or localized to a body site rather than diffuse Rash often starts in mucosal areas (e.g., genital, perianal, oral mucosa) and may not develop simultaneously in all body areas . The rash evolves through the following stages sequentially from macules (lesions with a flat base) to papules (slightly raised firm lesions), vesicles (lesions filled with clear fluid), pustules (lesions filled with yellowish fluid) and crusts which dry up and fall off. Proctitis: anorectal pain, tenesmus, and rectal bleeding; associated with visible perianal vesicular, pustular, or ulcerative skin lesions and proctitis Oropharyngitis: complicated by tonsillar swelling, abscess, dysphagia.

15. Signs & symptoms:-

16. Case defintion :-

17. Diagnosis Identifying mpox can be difficult as other infections and conditions can look similar . It is important to distinguish mpox from chickenpox, measles, bacterial skin infections, scabies, herpes, syphilis, other sexually transmissible infections, and medication-associated allergies. Someone with mpox may also have another sexually transmissible infection such as herpes. Alternatively, a child with suspected mpox may also have chickenpox. For these reasons, testing is key for people to get treatment as early as possible and prevent further spread. Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for mpox. The best diagnostic specimens are taken directly from the rash – skin, fluid or crusts – collected by vigorous swabbing . In the absence of skin lesions, testing can be done on oropharyngeal, anal or rectal swabs. Testing blood is not recommended. Antibody detection methods may not be useful as they do not distinguish between different orthopoxviruses . Lymphadenopathy is a distinctive feature of mpox compared to other diseases that may initially appear similar (chickenpox, measles, smallpox).

18. Differential diagnosis varicella zoster virus (VZV, chickenpox), herpes simplex virus (HSV), primary or secondary syphilis, disseminated gonococcal infection ( DGI ), foot and mouth disease, measles, scabies, rickettsia pox , medication-associated allergies lymphogranuloma venereum (LGV), granuloma inguinale , molluscum contagiosum zika virus, dengue fever, vasculitis and other bacterial skin and soft tissue infections Vaccinia The rash which develops in MPX may resemble other infectious diseases or other conditions, including :-

19. Treatment Symptomatic treatment Tecovirimat , “tpoxx” is approved by the FDA for the treatment of smallpox The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, is sponsoring a Phase 3 clinical trial evaluating the antiviral tecovirimat, also known as TPOXX, for the treatment of Mpox. The NIAID-funded ACTG is leading the study, which is now enrolling adults and children with Mpox infection in the United States and select sites internationally. Study investigators aim to enroll more than 500 people from up to 80 clinical research sites. Adults with severe Mpox, severe immunodeficiency, or severe inflammatory skin conditions; individuals taking certain medications that could affect tecovirimat levels; and pregnant people, people who are breastfeeding and children all will be enrolled in an open-label arm in which all participants receive tecovirimat. Other adult participants—530 total—will be randomly assigned in a 2:1 ratio to receive tecovirimat or placebo pills, which participants will take for 14 days.

20. Pre exposure prophylaxis:- ( Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control and Prevention (CDC ) People at risk of mpox should ideally be vaccinated prior to exposure to monkeypox virus (MPXV). People may be vaccinated after exposure to MPXV to help prevent mpox (i.e., post-exposure prophylaxis). Two vaccines may be used for the prevention of mpox: JYNNEOS vaccine is approved and recommended by CDC and ACIP for the prevention of mpox and smallpox. During the ongoing clade II MPXV outbreak (i.e., outbreak that began in 2022 affecting predominantly gay, bisexual, and other men who have sex with men), JYNNEOS has been the main vaccine used in the United States . https:// www.cdc.gov/poxvirus/mpox/interim-considerations/overview.html https:// www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7122e1-H.pdf ACAM2000 vaccine is approved for immunization against smallpox and could be made available for use against mpox under an Expanded Access Investigational New Drug (EA-IND) protocol. In the United States, there is a large supply of ACAM2000, but this vaccine has more known side effects and contraindications .

21. Pre exposure prophylaxis:- The standard regimen for JYNNEOS involves a subcutaneous ( Subcut ) route of administration with an injection volume of 0.5mL. An alternative regimen involving intradermal (ID) administration with an injection volume of 0.1mL may be used under an Emergency Use Authorization (EUA). Both the standard (0.5mL Subcut ) and the alternative (0.1mL ID) regimen have been found to be effective for mpox prevention. JYNNEOS vaccine is licensed as a series of two doses administered 28 days (4 weeks) apart. Administration of additional JYNNEOS vaccine doses (more than 2 doses) is currently not recommended. For those at occupational risk of exposure to orthopoxviruses (e.g., certain research laboratorians*) a booster is recommended at 2-10 years depending on the type of work being performed. People who are vaccinated should continue to take steps to protect themselves from infection by avoiding close, skin-to-skin contact, including intimate contact, with someone who has mpox For people with sexual risk factors for mpox who have not been diagnosed with mpox during the ongoing outbreak or have not already received 2 doses of the JYNNEOS vaccine, CDC routinely recommends vaccination.

22. Post exposure prophylaxis Mpox vaccine can be given as post-exposure prophylaxis (PEP) both to people with known or presumed exposure to monkeypox virus ( MPXV) and people with certain risk factors and recent experiences that might make them more likely to have been exposed to mpox. As PEP, vaccine should be given as soon as possible , ideally within four days of exposure ; administration 4 through 14 days after exposure may still provide some protection against mpox . After 14 days, clinicians should consider the benefits of receiving vaccine on a case-by-case basis ; benefits might still outweigh risks when administering vaccine in some clinical situations (e.g., for a severely immunosuppressed person with a recent sex partner confirmed to have mpox ). Any person with ongoing risk of mpox exposure should be offered vaccination , even if previously exposed, and regardless of time since exposure, as long as they have not yet developed signs or symptoms of mpox . Vaccination given after the onset of signs or symptoms of mpox, after a diagnosis of mpox, or after recovery from mpox is not expected to provide benefit. At this time, naturally acquired mpox is believed to confer immune protection, although duration of immunity is unknown

23. Vaccination Schedule :-